Carepath for overcoming psychosis early (COPE): first 5 years of clinical operation and prospective research in the Cavan-Monaghan early intervention service.

OBJECTIVES: As Ireland confronts the many challenges of broadening the introduction of early intervention services (EIS) for first episode psychosis (FEP) as national policy, this article describes Carepath for Overcoming Psychosis Early (COPE), the EIS of Cavan-Monaghan Mental Health Service, and presents prospective research findings during its first 5 years of operation. METHODS: COPE was launched as a rural EIS with an embedded research protocol in early 2012, following an education programme for general practitioners (GPs). Here, operational activities are documented and research findings presented through to late 2016. RESULTS: During this period, 115 instances of FEP were incepted into COPE, 70.4% via their GP and 29.6% via the Emergency Department. The annual rate of inception was 24.8/100,000 of population aged > 15 years and was 2.1-fold more common among men than women. Mean duration of untreated psychosis was 5.7 months and median time from first psychotic presentation to initiation of antipsychotic treatment was zero days. Assessments of psychopathology, neuropsychology, neurology, premorbid functioning, quality of life, insight, and functionality compared across 10 DSM-IV psychotic diagnoses made at six months following presentation indicated minimal differences between them, other than more prominent negative symptoms in schizophrenia and more prominent mania in bipolar disorder. CONCLUSIONS: COPE illustrates the actuality of introducing and the challenges of operating a rural EIS for FEP. Prospective follow-up studies of the 5-year COPE cohort should inform on the effectiveness of this EIS model in relation to long-term outcome in psychotic illness across what appear to be arbitrary diagnostic boundaries at FEP.

Weekend versus weekday hospital deaths: analysis of in-patient data in a Nigerian tertiary healthcare center.

AIM: This study aims at comparing weekday deaths to weekend deaths of in-patients of a tertiary hospital in Nigeria. MATERIALS AND METHODS: This is a 10-year retrospective survey conducted at the Nnamdi Azikiwe University Teaching Hospital in which the death records of the hospital were accessed from the various wards and health records department to extract relevant data pertaining to the time of hospital death. Tests of statistical significance were done using Chi-square test at 95% confidence intervals. RESULTS: A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The male to female ratio was 1.2:1. An average of 547 weekend deaths and 568 weekday deaths were recorded, giving a ratio of 0.96:1. A ratio of weekend to weekday death rate of 0.99:1 and 0.93:1 for the males and females, respectively was noted. The labor ward, followed by the intensive care unit (ICU) had the highest weekend to weekday death ratio of 1.72:1 ( P = 0.0461) and 1.41:1 ( P = 0.1440), respectively. Weekend deaths were less in the other wards, with the gynaecological ward having the least ratio of 0.63:1 ( P = 0.7360). CONCLUSION: The rate of hospital deaths was generally found not to vary significantly over the weekends and weekdays in the hospital except for the labor ward which had significantly higher weekend to weekday death rates of 1.72:1. There is therefore need for confidential enquiry into the causes of hospital deaths, especially in the labor ward, in order to identify and prevent avoidable deaths.

Weekend Versus Weekday Hospital Deaths: Analysis of In-Patient Data in a Nigerian Tertiary Healthcare Center

Aim: This study aims at comparing weekday deaths to weekend deaths of in-patients of a tertiary hospital in Nigeria. Materials and Methods: This is a 10-year retrospective survey conducted at the Nnamdi Azikiwe University Teaching Hospital in which the death records of the hospital were accessed from the various wards and health records department to extract relevant data pertaining to the time of hospital death. Tests of statistical significance were done using Chi-square test at 95 confidence intervals.Results: A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The male to female ratio was 1.2:1. An average of 547 weekend deaths and 568 weekday deaths were recorded; giving a ratio of 0.96:1. A ratio of weekend to weekday death rate of 0.99:1 and 0.93:1 for the males and females; respectively was noted. The labor ward; followed by the intensive care unit (ICU) had the highest weekend to weekday death ratio of 1.72:1 (P = 0.0461) and 1.41:1 (P = 0.1440); respectively. Weekend deaths were less in the other wards; with the gynaecological ward having the least ratio of 0.63:1 (P = 0.7360). Conclusion: The rate of hospital deaths was generally found not to vary significantly over the weekends and weekdays in the hospital except for the labor ward which had significantly higher weekend to weekday death rates of 1.72:1. There is therefore need for confidential enquiry into the causes of hospital deaths; especially in the labor ward; in order to identify and prevent avoidable deaths

Proximate determinants of antenatal care utilization among women in southeastern Nigeria.

BACKGROUND: In order to scale up Antenatal services, there is need to determine the factors that deter women from accessing antenatal care. AIM: To determine the proximate factors that affect utilization of antenatal care among market women in Nnewi, southeastern Nigeria. MATERIALS/METHOD: A cross sectional survey of 400 market women using semi structured questionnaires and focus group discussions. RESULT: Out of the 398 studied women, 97.2% attended antenatal care in their last pregnancy. Most (64.5%) of them booked after the third trimester and majority of the women received antenatal care from the private specialist hospitals (37.4%), followed by the private general practice hospitals (34.7%) and government hospitals (17.8%). The main reasons for choosing antenatal care facilities were the perceived friendliness of the staff (33.9%), availability of staff always (27.4%) and proximity of the facility (17.4%). Financial considerations accounted for 4.5% of the reasons for the choice of facility. There was no significant influence of age, parity and religion on the utilization of antenatal care. However, the likelihood of ANC attendance was significantly lower among the house wives (x2 = 14.2; p = 0.0). There was no association between choice of facility for ANC and age, parity, occupation or religion. The main reasons identified by the FGD discussants for preferring the private hospitals were more friendly and available staff. Also late booking was mainly attributed to wrong advice from friends and husbands refusal to provide money. Antenatal care attendance rate was high among the studied women and most of the women utilize private hospitals for care. Staff friendliness and availability at all times were the main reasons for choice of ANC facilities. There is the need to address the negative attitudes of the staff in government hospitals.

Contraceptive choices and practices among urban women in southeastern Nigeria.

BACKGROUND: Determining the contraceptive choices among the women is the first step in scaling up family planning methods. OBJECTIVE: To determine the contraceptive choices and practices as well as the underlining factors among market women in Nnewi, southeastern Nigeria. SUBJECTS/METHOD: This is a cross sectional descriptive study of market women, that assessed their contraceptive choices and practices. RESULT: Knowledge about family planning was 96.5%. One hundred and seventy five (44.0%) of the interviewed women were currently using a family planning method while 59.0% had ever used a method. The common methods in use were the natural method (24.1%), withdrawal method (7.5%) and the IUCDs (6.1%). The commonest ever used method was the natural method (26.7%) followed by withdrawal method (10.6%) and condom (7.8%). Fear of family planning commodities interfering with future fertility was the commonest reason for non use of family planning services (14.6), followed by the fear of the side effects (10.6%). Seventy one (17.8%) of the non-users had no reason. The use of family planning services was significantly high among the women aged 35 and above (x2 = 9.98; P = 0.04) and the (x2 = 23.8; P = 0.00). Focus group discussions indicated that husband's refusal, fear of side effects, cancer and delayed fertility were the main barriers to the use of family planning methods. CONCLUSION: The contraceptive prevalence rate among Nnewi market women is high and cuts across all religions and social classes. However, the methods in common use are associated with high failure rates. The use of the more reliable methods should be encouraged.

Inevitable caesarean myomectomy; a case report.

The standard teaching is to avoid caesarean myomectomy as much as possible for the fear of the attendant severe haemorrhage. Classical caesarean section in spite of its risk of uterine rupture in subsequent pregnancies had been prescribed in its place. We report a case of a 32 year old nullipara who had an inevitable removal of a huge intramural fibroid in order to assess the baby. A high dose oxytocin infusion, and skillful surgery ensured minimal intra operative and post operative blood loss.

Inevitable caesarean myomectomy.

The standard teaching is to avoid caesarean myomectomy as much as possible for the fear of the attendant severe haemorrhage. Classical caesarean section in spite of its risk of uterine rupture in subsequent pregnancies had been prescribed in its place. We report a case of a 32 year old nullipara who had an inevitable removal of a huge intramural fibroid in order to assess the baby. A high dose oxytocin infusion, and skillful surgery ensured minimal intra operative and post operative blood loss.

Inevitable Caesarean Myomectomy

The standard teaching is to avoid caesarean myomectomy as much as possible for the fear of the attendant severe haemorrhage. Classical caesarean section in spite of its risk of uterine rupture in subsequent pregnancies had been prescribed in its place.We report a case of a 32 year old nullipara who had an inevitable removal of a huge intramural fibroid in order to assess the baby. A high dose oxytocin infusion; and skillful surgery ensured minimal intra operative and post operative blood loss

Serum urea and uric acid concentration in pregnant women in sub-urban commercial community in Africa.

Serum uric acid and urea levels were determined in 27 pregnant and 17 non-pregnant black African women. Uric acid levels for the pregnant women were significantly raised, and the relationship between uric acid elevation and gestational proteinuric hypertension was discussed. In conclusion, we recommend that uric acid estimation should be included during routine antenatal clinics in normal pregnancy. That the use of uric acid levels should be encouraged for the diagnosis and management of gestational proteinuric hypertension in African pregnant women. The above recommendation will help to reduce prenatal morbidity and mortality in African pregnant women.

Inevitable caesarean myomectomy.

The standard teaching is to avoid caesarean myomectomy as much as possible for the fear of the attendant severe haemorrhage. Classical caesarean section in spite of its risk of uterine rupture in subsequent pregnancies had been prescribed in its place. We report a case of a 32 year old nullipara who had an inevitable removal of a huge intramural fibroid in order to assess the baby. A high dose oxytocin infusion, and skillful surgery ensured minimal intra operative and post operative blood loss.

Contraceptive choices among Nigerian women attending an antenatal clinic.

The factors determining the choice of contraception were studied among 230 pregnant women attending the antenatal clinic at Nnewi, Nigeria. There were 174 (52.1%) choices for the natural methods of contraception, 86 (25.7%) for the traditional methods, and 74 (22.2%) for the artificial methods. The most commonly chosen contraceptive methods were rhythm, 95 (28.4%) and Billings, 79 (23.5%), while the least was surgical contraception, 4 (1.2%). The barrier method was not chosen at all. The most common reason given for choice of contraception was safety, 28.7%, followed by dislike of artificial methods, 25.2%; the no-response rate was 29.1%. Other reasons given were ease of use, 10%; husband's decision, 1.3%; fear of the complications of the artificial methods, 13%; dislike of foreign body, 2.6%; the method most understood, 24.8%; need for further counselling, 7%; and long-lasting, 2.6%. The most common reason given against the use of the artificial methods of contraception was fear of its complications, 31.9%, followed by preference for the natural methods, 22.3%. Condom use decreased with increasing age, being highest at 16-20 years, 37.5%, and lowest at 31-35 years, 5.9%. When compared with other parity groups, the grandmultipara group (> or = 5) used the IUD, 14.3%; injectable contraception, 4.8%; and other traditional methods (breastfeeding and abstinence), 28.5%, and did not use the rhythm method. Women of the lowest social class most commonly chose other traditional methods, 57.1%, and never chose the Billings method. Women who desired 1 to 3 children most commonly chose the pill, 23.5%, or withdrawal method, 23.5%, while women who desired 4 to 10 children most commonly chose the rhythm and Billings methods. There was no difference in choice of method of contraception for the various religious denominations, although the artificial methods were less commonly chosen by Catholics, 14.1%, compared with Anglicans, 33%, and other Christian denominations, 33.3%. The physician was the most common source of information for the choosers of the condom, 18.9%; surgical contraception, 2.7%; and the pill, 8.1%; the nurse for injectable contraception, 4.9%, while the commonest source of information among choosers of the rhythm method was the electronic media, 40.5%; print media, 34.9%; and peer group, 34.4%. Lecture/sex instruction was the commonest source of information among choosers of the Billings, 35.5%, and withdrawal, 22.6%, methods, while the no-response rate on source of information on contraception was highest among choosers of the Billings method. There is a need to bridge the gap in contraceptive information by redirecting counselling strategies and restructuring family planning programs to dispel negative perceptions and encourage informed choice of effective family planning methods.

Family planning knowledge and practice among Nigerian women attending an antenatal clinic.

This study investigates family planning activity in 308 Nigerian women attending an antenatal clinic. Family planning awareness was present in 234 women (76%) and practice occurred in 168 (54.5%). Proposal to practice family planning occurred in 66 of 137 women who had never used contraception while 69 (22.4%) had no intention to practice family planning. The best-known type of contraception was the condom, 182 (59.1%); the most common used, the safe period (rhythm), 73 women (23.7%); while Billings' contraception was the most commonly proposed type, 72 women (23.4%). Knowledge of the beneficial effects of the chosen method of contraception was claimed by 102 women (43.6%) while 33 (14.2%) conceded ignorance of this. Similarly, 81 women (34.6%) claimed to know the adverse effects of their chosen method of contraception, while 119 (50.9%) admitted ignorance of it. The most common source of information on contraception was the printed media, 112 (47.9%), while the least common was lecture/sex instruction, 27 (11.5%). Lack of adequate information and ignorance are key factors militating against family planning practice in Nigeria. Family planning activity in Nigeria would be improved by wider dissemination of information on family planning through public lectures and the electronic media; training of family planning counselors to facilitate grass-roots coverage; universal entrenchment of family planning counseling into routine antenatal clinic activities; and integration of private medical centers into the national family planning service.